Hypokalemia-Consequences , Causes , and Correction

Hypokalemia-Consequences , Causes , and Correction,I. DAVID WEINER,CHARLES S. WINGO

Hypokalemia-Consequences , Causes , and Correction   (Citations: 14)
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Hypokalemia is one of the most commonly encountered fluid and electrolyte abnormalities in clinical medicine. It can be an asymptomatic finding identified only on routine electrolyte screening, or it can be associated with symptoms ranging from mild weakness to sudden death. The correction of hypokabemia can be simple, but if inappropriately performed can lead to worsening symptoms, and even death. The purpose of this article is to discuss the management of hypokalemia in sufficient detail to allow practitioners to care for patients who have this condition. We shall discuss the epidemiology of hypokalemia and its consequences on renal and extrarenal tissues and shall briefly discuss the physiology of potassium handling and the differential diagnosis of hypo- kalemia. Finally, we shall consider the important factors that should influence therapy and shall provide general recommen- dations for patient management. Space limitations preclude extensive reference to many of the primary sources of infor- mation; thus, comprehensive reviews are frequently cited. Epidemiology The occurrence of hypokalemia is strongly dependent on the patient population. In otherwise healthy adults not receiving any medications, less than 1% will develop hypokalemia, as defined by a serum potassium level of less than 3.5 mEq/liter. This very low frequency of hypokalemia is a testament to two factors: the adequacy of potassium in the typical Western diet, and potent mechanisms for renal potassium conservation in states of potassium depletion. The presence of spontaneous hypokabemia in otherwise healthy adults who are not receiving any medications should suggest the possibility of underlying disease and indicate the need to search for an etiology. Potassium deficiency alters the function of several organs and most prominently affects the cardiovascular system, neu- robogic system, muscles, and kidneys (2). These effects ulti- mately determine the morbidity and mortality related to this condition. Unfortunately, the correlation between degree of potassium deficiency and adverse side-effects is poor, possibly because the occurrence of side-effects is related to both the potassium deficiency and the underlying disease state. Overall, children and young adults tolerate more severe degrees of hypokalemia with less risk of severe side-effects than the elderly.
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    • ...In some conditions such as Bartter’s syndrome, additive treatment modalities need to be used (e.g. potassium supplementation, indomethacin, converting enzyme inhibitors) and even then success is limited.Prevention of HypokalemiaPrevention of potassium depletion is possible in patients receiving diuretics and in those undergoing gastric drainage. Because profound potassium depletion in these settings is almost exclusively the result of alkalosis, potassium depletion can be avoided by measures designed to prevent metabolic alkalosis. Thus, particular attention must be paid in these patients to providing a sufficient supply of chloride to ensure that a chloride deficit does not develop. Usually, chloride is given in the form of potassium chloride.Patients with diuretic-induced hypokalemia should be re-evaluated to reconsider the need for diuretics. If continual use is required, assessment of sodium intake should be performed. Excessive sodium intake may accentuate diuretic-induced hypokalemia [...

    Gheun-Ho Kimet al. Therapeutic Approach to Hypokalemia

    • ...5 mmol/L in the absence of potassium-depleting medications...

    Michael E. Andrewet al. Ethnicity and unprovoked hypokalemia in the Atherosclerosis Risk in Co...

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